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Epistaxis - Management
Basis for recommendation
These recommendations are mainly based on expert opinion in review articles [Pashen and Stevens, 2002; Wormald, 2002; Leong et al, 2005; Pope and Hobbs, 2005; Schlosser, 2009].
Choice of pack
- Evidence from randomized trials consistently shows that inflatable nasal packs and nasal tampons have similar efficacy for controlling bleeding in people with epistaxis. However, when compared with nasal tampons, inflatable nasal packs are more comfortable to insert and remove, and are easier to use [Badran et al, 2005; Singer et al, 2005; Moumoulidis et al, 2006].
- Compared with ribbon packing, nasal tampons are considered by experts to be more useful in the primary care setting [Kucik and Clenney, 2005]. For acute epistaxis, without specific training, packing with ribbon gauze can result in trauma to the septum and inferior turbinate [Wormald, 2002].
Referral once the nasal pack is inserted
- The recommendation to admit the person to hospital once the nasal pack is inserted is based on expert opinion in a review article [Wormald, 2002] and the risk of complications.
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